改良后路减压术治疗胸腰椎爆裂性骨折的病例对照研究

Application of modified posterior decompression for the treatment of thoracolumbar burst fractures

目的:探讨自制椎管减压器在胸腰椎爆裂性骨折中的应用效果,为推广应用提供依据。方法:自2008年1月至2008年12月,采用自行设计的椎管减压器后路手术治疗胸腰椎爆裂性骨折43例,男30例,女13例;年龄22～49岁,平均(29.4±2.5)岁。损伤节段:T1216例,L119例,L28例。骨折类型按Denis法分为:A型12例,B型24例,D型6例,E型1例。将术中出血量、术后24h伤口引流量、手术时间等指标与先前行传统后入路手术的16例胸腰椎爆裂骨折患者的相应结果进行比较。另对术前及术后的椎管容积、Cobb角、残留椎体高度、神经功能症状、后背疼痛等项目进行评价。结果:所有患者伤口Ⅰ期愈合,无切口感染、神经损伤等并发症。43例均获随访,时间12～24个月,平均(16.5±2.5)个月。改良后路手术与传统后路手术在术中出血量、手术时间方面的差异有统计学意义,但在术后24h伤口引流量方面差异无统计学意义。43例患者术前和术后CT显示椎管占位分别为(49.4±16.7)%和(12.8±4.2)%;X线片显示Cobb角术前及术后分别为(30.1±2.4)°和(5.1±0.6)°,平均椎体高度术后恢复率为(81.5±5.5)%。随访中33例神经功能得到恢复,Frankel分级平均提高0.87级。无神经功能恶化出现。结论:在胸腰椎爆裂性骨折后路手术中应用自行设计椎管减压器可以安全有效进行椎管减压,恢复伤椎椎体高度,重建前中柱的稳定性,防止术后椎体高度和矫正Cobb角的再丢失。

Objective：To study therapeutic effects of self-designed canal decompressor in the posterior surgical treatment of thoracolumbar burst fractures,and provide evidence for widespread application.Methods：From January 2008 to December 2008,the self-designed canal decompressor was used in 43 patients（30 males and 13 females,ranging in age from 22 to 49 years） with thoracolumbar burst fractures.According to Denis classification,there were 12 cases of type A,24 cases of type B,6 cases of type D and 1 case of type E.Affected segment：16 patients in T12,19 patients in L1 and 8 patients in L2.The index of intra-operative blood loss,postoperative 24 h wound drainage volume,and operative time were compared with those of 16 patients who undergone traditional operation.The preoperative and postoperative vertebral canal volume,Cobb angles,residual vertebral body height,neurological outcome,and back pain were evaluated and compared.Results：All the patients healed without wound infection,neurological symptoms and other complications.Forty-three patients were followed up ranging from 12 to 24 months,with a mean of（16.5±2.5） months.Compared with traditional posterior operation,the blood loss and operative time in modified posterior approach group had statistically significant difference,but the postoperative 24 h wound drainage had no significant difference between the two groups.CT scan indicated that applying the canal decompressor allowed efficient restore of canal volume from preoperative（49.4±16.7）% to postoperative（12.8±4.2）%.The X-ray showed Cobb angles reduced from preoperative（30.1±2.4）°to postoperative（5.1±0.6）°.Mean vertebral height was restored to（81.5±5.5）% after operation.Follow-up evaluation indicated that neurological recovery presented in 33 patients,with an average improvement of 0.87 Frankel grades.Neurological deterioration was not observed.Conclusion：Applying the canal decompressor enables efficient and safe spinal decompression,restore the height of the injured vertebrae,reconstruction of the anterior-middle column stability,and prevention of postoperative vertebral height and Cobb angle lost.